Neti Pots have become common fixtures in many homes to flush out clogged nasal passages and help people to breathe easier. Neti pots and other Nasal Irrigation Devices (NID) which include bulb syringes, squeeze bottles, and battery-operated pulsed water devices, use salty water (saline) to help provide relief from sinus congestion, colds and allergies. They’re also used to moisten nasal passages exposed to dry indoor air.  According to the U.S. Food and Drug Administration (FDA), improper use of neti pots and other NID can actually increase your risk of infection and expose you to potentially life-threatening bacteria.

In 2011, two cases were reported in Louisiana where patients contracted infections after using neti pots filled with “safe” tap water. A 20-year-old man and a 51-year-old woman both died from bacterial infections traced to their Neti Pots.

The culprit was an amoeba called Naegleria fowleri, which is commonly found in lakes, rivers and hot springs. This kind of infection is exceedingly rare, but it usually occurs when people get water up their nose after swimming or diving in lakes or rivers.

Naegleria fowleri can travel from the nose into the brain, where it causes primary amoebic meningoencephalitis, a disease that destroys brain tissue and is almost always fatal.

Naegleria infection may be mild at first and include headache, fever, nausea, or vomiting. Later symptoms may include stiff neck, confusion, seizures, and hallucinations. The disease generally causes death within about 5 days after symptoms start. In 123 known cases from 1962 to 2011 in the United States, only one person has survived, according to the Centers for Disease Control and Prevention.

If you are irrigating, flushing, or rinsing your sinuses, for example, by using a neti pot, use distilled, sterile or previously boiled water to make up the irrigation solution,” said Louisiana State Epidemiologist, Dr. Raoult Ratard.

These nasal rinse devices are usually safe and effective products when used and cleaned properly“, says Eric A. Mann, MD, PhD, a doctor at the US FDA.

Tap water isn’t really safe for use as a nasal rinse because it’s not adequately filtered or treated for nasal use.  Some tap water contains low levels of organisms — such as bacteria and protozoa, including amoebas — that may be safe to swallow because stomach acid kills them. But in your nose, these organisms will stay alive in nasal passages and cause potentially serious infections. They can even be fatal in some rare cases, according to the Centers for Disease Control and Prevention (CDC).

 

What Types of Water Are Safe to Use in a Neti Pot?

  • Distilled or sterile water, which you can buy in the Pharmacy or First Aid section of the grocery store. The label must state “distilled” or “sterile.”
  • Boiled and cooled tap water — boiled for at least 5 minutes, then cooled until it is lukewarm.
    • Don’t cool boiled water with ice cubes, or tap water – it defeats the purpose and allows for further bacterial contamination.
    • Previously boiled water can be stored in a clean, closed container for use within 24 hours.
  • Water passed through a filter designed to trap potentially harmful bacteria
    • I recommend protecting the ENTIRE household with an appropriately designed and installed Ultraviolet Disinfection System
    • In addition to that, make sure that the water being used has been passed through a 1 micron or smaller filter (I like point-of-use Carbon block/Ultrafiltration (UF) combination filters).

 

Safely Using Nasal Irrigation Systems

Always make sure that you actually follow the usage instructions. There are various ways to deliver a saline solution into your nose. Nasal spray bottles deliver a fine mist and might be useful for moisturizing dry nasal passages, while irrigation devices are better at flushing the nose and clearing out mucus, allergens and other foreign material.

Information included with the irrigation device might give more specific instructions about its use and care. These devices all work in basically the same way:

  • Leaning over a sink, tilt your head sideways with your forehead and chin roughly level to avoid liquid flowing into your mouth.
  • Breathing through your open mouth, insert the spout of the saline-filled container into your upper nostril so that the liquid drains through the lower nostril.
  • Clear your nostrils. Then repeat the procedure, tilting your head sideways  to the other side.

Sinus rinsing can remove dust, pollen and other debris, as well as help to loosen thick mucus. It can also sometimes help to relieve nasal symptoms of sinus infections, allergies, colds and flu. The saline allows water to pass through delicate nasal membranes.

If your immune system isn’t working properly or compromised in any way, consult with your health care provider before using a Neti Pot or any other nasal irrigation systems.

Recommended procedure for safely using Nasal Irrigation Devices:

  • Wash and dry your hands.
  • Check that the device is clean and completely dry.
  • Rinse the device with Hydrogen Peroxide.
  • Prepare the salt water rinse.
  • Follow the manufacturer’s directions for use.
  • Wash the device with warm soapy water.
  • Rinse the device with Hydrogen Peroxide and allow it to air dry.

Consult with your health care provider or pharmacist if the instructions on your device do not clearly state how to use it or if you have any questions.

 

Nasal Rinsing Devices and Children

Finally, make sure the device fits the age of the person using it. Some children are diagnosed with nasal allergies as early as age 2 and could benefit from the use of nasal rinsing devices  if a pediatrician recommends it.  Whether for a child or adult, talk to a medical expert to determine whether nasal rinsing will actually be safe, beneficial, or effective for the specific health condition.

If symptoms are not relieved or worsen after nasal rinsing, then return to your health care provider, especially if you experience fever, nosebleeds or headaches while using the device.

Health care professionals and patients can report problems about nasal rinsing devices to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program.

Additional Reading

Cope JR, Ratard RC, Hill VR, Sokol T, Causey JJ, Yoder JS, Mirani G, Mull B, Mukerjee KA, Narayanan J, Doucet M, Qvarstrom Y, Poole CN, Akingbola OA, Ritter JM, Xiong Z, da Silva A, Roellig D, Van Dyke R, Stern H, Xiao L, Beach MJ. The first association of a primary amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a U.S. treated public drinking water system.External Web Site Icon Clin Infect Dis. 2015;DOI: 10.1093/cid/civ017.

Dorsch MM, Cameron AS, Robinson BS. The epidemiology and control of primary amoebic meningoencephalitis with particular reference to South Australia.External Web Site Icon Trans R Soc Trop Med Hyg. 1983;77(3):372-7.

Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC, Hill V, Wilson JD, Linscott AJ, Crager R, Kozak NA, Sriram R, Narayanan J, Mull B, Kahler AM, Schneeberger C, da Silva AJ, Beach MJ. Deaths from Naegleria fowleri associated with sinus irrigation with tap water: a review of the changing epidemiology of primary amebic meningoencephalitis.External Web Site Icon Clin Infect Dis. 2012;1-7.

Shakoor S, Beg MA, Mahmood SF, Bandea R, Sriram R, Noman F, Ali F, Visvesvara GS, Zafar A. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan. Emerg Infect Dis. 2011;17(2):258-61.

CDC. Primary amebic meningoencephalitis associated with ritual nasal rinsing — St. Thomas, U.S. Virgin Islands, 2012. MMWR Morb Mortal Wkly Rep. 2013;62(45):903.

Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial.External Web Site Icon J Fam Practice. 2002;51(12):1049-55.

Rabago D, Zgierska A. Saline nasal irrigation for upper respiratory conditions.External Web Site Icon Am Fam Physician. 2009;80(10):1117-9.